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Last Set 2 Flashcards

1
Q

In what gestational week does they thyroid begin to develop?

Embryonic origin?

A

Third week of gestation

Derived from endoderm from the floor of the primitive pharynx

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2
Q

Hypothyroidism will cause elevation in what labs?

A

LDL and Total cholesterol

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3
Q

Attributable risk?

A

(A/ A+B) - (C/ C+D)

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4
Q

Orphan annie eyes

A

Papillary thyroid cancer

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5
Q

Mutation of papillary thyroid cancer

A

RET gene mutation

BRAF

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6
Q

Uniform cuboidal cells lining follicles and invading capsule

  • spread
  • associated with
A

Follicular thyroid carcinoma

Hematogenously
RAS mutation
PAX8-PPAR gamma 1 rearrangment

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7
Q

Tumor of thyroid
Increased level of calcitonin

Associated with
Mutation

A

Medullay thyroid carcinoma

Proliferation of parafollicular C cells

RET gene mutation
MEN 2A and MEN2B

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8
Q

What type of cancer in thyroid?

1) Arises from parafollicular C cells
2) RAS mutation or a PAX8-PPARy-1 rearrangment
3) Rearrangement in RET oncogene
4) Mutation in BRAF gene
5) Enlarged thyroid cells with ground-glass nuclei

A

1) Medullary thyroid carcinoma
2) Follicular thyroid carcinoma
3) Medullary thyroid carcinoma, papillary carcinoma
4) Papillary carcinoma
5) Papillary thyroid cancer

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9
Q

Lipodystrophy

Caused by

A

Distortions in the structure or function of adipose tissue

Buffalo hump

Leptin deficiency
HIV medication
- Protease inhibitors

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10
Q

Deficient in factor IX

A

Hemophilia B

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11
Q

Deficient in Factor VIII

A

hemophilia A

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12
Q

RL step of coagulation pathway

A

Factor X

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13
Q

Warfarin inhibits

A 
Factor II (thrombin)
Factor VII (extrinsic)
Factor IX (intrinsic) 
Factor X
Protein C 
Protein S
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14
Q

What is essential for coagulation cascade

A

Calcium

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15
Q

Factor XI

A

Kallikrein

Activates plasminogen –> plasmin (breaks down fibrin mesh)

Produces Bradykinin

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16
Q

Prothrombin time (PT)

A

Add tissue factor and see how long for clot to form

Test

  • Tissue factor pathway
  • Final common pathway

Factor VII
Factor X
Factor V
Factor II (prothrombin)

Resported with INR

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17
Q

Partial thromboplastin time (PTT)

A

25-40 seconds

Taking plasma add material to activate contact activation pathway

Factor XII
Factor XI
Factor IX
Factor VIII
Factor X
Factor V
Factor II (prothrombin)
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18
Q

Hemophilia A and B

  • deficiency
  • increases
A

Hemophilia A
- Factor VIII deficiency

Hemophila B
- Factor IX deficiency

Increase PTT

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19
Q

Coagulation disorders vs platelet disorders cause what type of bleeding

A

Coagulation disorders
- macrohemorrhages

Platelet disorders
- Microhemorrhages

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20
Q

Vit K deficiency

A

Cofactor for several clotting factors

Factor II, VII, IX, X, C and S

diSCo started in 1972

Increase PT and PTT

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21
Q

Antithrombin deficiency

  • resistant to
A

Hypercoagulable

Unable to inactivate thrombin

Resistant to heparin

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22
Q

Protein C deficiency

A

Hypercoagulable

Unable to inactivate factor V and VIII

or deficiency in protein S

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23
Q

Which glomerular disease should be suspected most in patients with each of the following findings?

  1. IF: granular pattern of immune complex deposition; LM; diffuse capillary thickening
  2. IF: granular pattern of immune complex deposition; LM: hypercellular
  3. IF: linear pattern of immune complex deposition
  4. EM: subendothelial humps and “tram track” appearance
  5. Nephritis, deafness, cataracts
  6. LM: crescent formation in the glomeruli
  7. LM: segmetnal sclerosis and hyalinosis
  8. EM spiking on the GBM due to electron-dense subepthelial deposits
A
  1. Membranous GN
    Diffuse proliferative GN
  2. Acute post-streptococcal GN
  3. Goodpasture syndrome
  4. Membranoproliferative GN
  5. Alport syndrome
  6. Rapidly progressive GN
  7. Focal segmental glomerulosclerossi
  8. Membranous GN
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24
Q

RBC with uniform spikes all over surface

A

Burr cell
Echinocyte

Uremia
Renal failure
Pyruvate kinase deficiency

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25
RBC with irregular spikes in size and distribution
Spur cell Acanthocyte Abetalipoproteinemia
26
RBCs looks like bulls eye
Target cells "HALT" said the hunter to his target Hemoglobin C disease Asplenia Liver disease Thalassemia
27
Tear drop RBCs
Myelofibrosis
28
An 18-year-old woman presents to the emergency department with acute onset of severe abdominal pain. She says she had a similar attack 1 year earlier after taking some barbiturates. At that time she underwent an exploratory laparotomy, which revealed nothing. The patient no longer takes barbiturates but recently started an extremely low-carbohydrate and low-calorie diet. She has a temperature of 37°C (98.6°F), a respiratory rate of 16/min, and a blood pressure of 128/83 mm Hg. Her WBC count is normal. Laboratory studies reveal a sodium level of 127 mEq/L, and urinalysis shows increased porphobilinogen levels. The physician tells the patient that she has a genetic condition involving her RBCs. What congenital disorder did the physician most likely tell the patient she has? (A) Acute intermittent porphyria (B) Fanconi’s anemia (C) Hereditary spherocytosis (D) Porphyria cutanea tarda (E) Sickle cell disease
A. Acute intermittent porphyria
29
Deficiency in Acute intermittent porphyria Excess
deficit in uroporphyrinogen 1 synthetase (porphobilinogen deaminase) Excess δ-aminolevulinate and porphobilinogen in the urine.
30
Dark red urine Psychologic disturbances Polyneuropathy Abdominal pain - deficiency - drug that precipitated Treatment
Acute intermittent porphyria Uroporphyrinogen-1 synthase (porphobilinogen deaminase) Precipitated by - Barbiturates - Seizure durgs - rifampin - metoclopramide Give Heme and Glucose - down regulates delta-ALA synthase
31
Sun sensitivity --> blistering Tea colored urine Excess hair growth Hyperpigmentation - associated with - increased lab - deficiency
Porphyria cutanea tarda Associated with hepatitis C and alcoholism Increase LFTs Uroporphyrinogen decarboxylase AD Build up uroporphyrinogen III
32
``` Abdominal pain Renal failure Mental deterioration Foot/ wrist drop Memory loss ``` Tx
Lead poisoning EDTA Succinmer Severe poisoning in child - Dimercaprol + succimer
33
RL step of Heme synthesis
delta-ALA synthase
34
Chipmunk face Hair on end appearance on xray of skull Target cells
Beta thalassemia Major | Increase Hemoglobin F 2 alpha, 2 gamma
35
What is the RL step of beta oxidation of fatty acids
Carnitine acyltransferase I
36
``` Hypersegmented neutrophila Anemia Glossitis Neurologic deficits Increased homocysteine INcreased MMA ```
B12 deficiency
37
Hypersegmented neutrophils Glossitis Increased homocysteine Normal methylmalonic acid
Folate deficiency
38
Anemia Increased CMV Hypersegmented neutrophils Orotic acid in urine -deficiency
Orotic aciduria Deficiency of UMP synthase
39
ADAMTS13
TTP
40
6. Low-molecular-weight heparins (LMWH) are distinct from unfractionated heparin in several ways. Which of the following is the primary target of LMWH? (A) Antithrombin III (B) Factor IIa (C) Factor VII (D) Factor Xa (E) Factors II, IX, and X
(D) Factor Xa LMWH act on Xa
41
Eczema Recurrent infections Thrombocytopenia
Wiskott-aldrich syndrome
42
Von Willebrand disease | tx
DDAVP - desmopressin (ADH analog) ADH increase release of vWF from storage sites in endothelial cells
43
t (8;14)
Burkitt lymphoma c-MYC Starry sky appearance
44
t(14;18)
Diffuse large B cell lymphoma -Elderly Follicular lymphoma
45
t(11;14)
Mantle cell lymphoma Disruption of regulation of cyclin D
46
t(15;17) tx
M3 AML Treat w/ all-trans retinoic acid
47
Rouleaux formation
RBC stacked like coins MM
48
Myeloproliferative neoplasma 3 types mutation
Monclonal proliferation of mature myeloid cells Types - polycythemia vera - essential thrombocytosis - myelofibrosis Mutation - JAK2
49
Liver metastasis
"Cancer Sometime Penetrates Benign Liver" ``` Colon Stomach Pancreas Breast Lung ``` Colon >> stomach > pancreas ``` Elevated LFTs Abdominal pain Hepatomegaly Ascites Jaundice ```
50
Brain Metastasis
"Lots of Bad Stuff Kills Glia" ``` Lung Breast Skin (melanoma) Kidney GI tract ``` Lung > breast > melanoma, colon, kidney HA Neurological deficits Cognitive function Seizures Well circumscribed tumors at grey/white matter junctions
51
Bone Metastasis
"Permanently Relocated Tumors That Like Bone" ``` Prostate Renal cell cancer Testes Thyroid Lung Breast ``` Prostate, breast > lung, thyroid, kidney
52
Mutation in APC - type mutation - seen in
Tumor suppressor genes Negative regulator of beta-catenin/WNT pathway Familial adenomatous polyposis Colon cancer
53
NF1 mutation - type of mutation - chromosome - presentation
Tumor suppressor protein - Neurofibromin (Ras GTPase activating protein) NF type 1 Neurofibromas, cafe au lait spots Chr 17
54
NF2 mutation - type of mutation - chromosome - presentation
Tumor suppressor protein - Merlin (schwannomin) protein NF type 2 Bilateral acoustic schwannoma chr 22
55
K-RAS mutation H-Ras mutation N-RAS mutation - type - seen in
oncogene mutation Colon Lung Pancreatic tumors Bladder and kidney tumors Melanomas Hematologic malignancies Follicular thyroid cancer
56
RET mutation - type mutation - associated with
oncogene mutation - receptor tyrosine kinase MEN 2A and 2B - Pheochromocytoma - Medullary thyroid cancer Papillary carcinoma of thyroid
57
c-myc - type mutation - seen in
oncogene mutation - transcription factor burkitt lymphoma
58
What is the RL enzyme in purine synthesis? RL enzyme in pyrimidine synthesis?
Purine: Glutamine PRPP amidotransferase Pyrimidine: Carbamoyl phosphate synthase 2
59
Tartrate-resistant acid phosphatase (TRAP)
Hairy cell leukemia
60
RL enzymes for each? 1. Urea cycle 2. Hexose monophosphate pathway 3. Fatty acid synthesis 4. Beta-oxidation of fatty acids 5. Ketone body synthesis 6. Cholesterol synthesis 7. Bile acid synthesis 8. Heme synthesis
1. Carbamoyl phosphate synthetase I 2. Glucose 6 phosphate dehydrogenase 3. Acetyl CoA carboxylase 4. Carnitine acyltransferase 5. HMG CoA synthase 6. HMG CoA reductase 7. 7-alpha hydroxylase 8. Aminolevulinate synthase
61
What are the irreversible enzymes involved in gluconeogenesis?
Pyruvate carboxylase (pyruvate --> oxaloacetate) PEP carboxykinase (oxaloacetate --> phosphoenolpyruvate) Fructose 1,6 bisphosphatase (Fructose 1,6- bisphosphate --> Fructose 6 phosphate) Glucose 6 phosphate (Glucose 6 phosphate --> glucose)
62
Transfusion reactions
Type II hypersensitivity
63
Lupus - type of rxn - deficiency of
type II hypersensitivity C1q, C4, C2
64
Fluoxetine affects neurons arising from
SSRI From Raphe nucleus
65
NE is from
Locus cereuleus
66
GABA from
Nucleus accumbens
67
Dopamine from
Ventral tegmentum SNc
68
Leukomoid vs CML
Leukomoid - high alkaline phosphate (LAP) CML - low leukocyte alkaline phospahtase
69
``` Fever Diarrhea Splenomegaly Muscle wasting Pancytopenia ```
Bitten sand fly Leishmania spp
70
Leukotrienes do what
LTC4 LTD4 LTE4 Increase bronchial tone LBT4 - increase neutrophil chemotaxis
71
Prostacyclin do what
Decrease platelet aggregation Decrease vascular tone
72
Prostaglandins do what
Decrease vascular tone Increase uterine tone
73
Thromboxane do what
Increase platelet aggregation Increased vascular tone
74
Pulmonary embolism does what to pH, PaO2, PaCO2, Serum HCO3
pH increase PaO2 decrease PaCO2 decrease Serum HCO3 Normal PE occludes parenchyma resulting in increased dead space ventilation Hyperventilation --> hypocapnia and respiratory alkalosis Acute so no bicarb involvement yet
75
Bacteria virulence factor simlar to tropomyosin and myosin. Fxn
M protein Resist phagocytosis Group A streptococcus - S pyogenes - cross rxn causes rheumatic carditis
76
Decreased pulmonary capillary wedge pressure
Right sided heart failure Impaired blood flow from right ventricle to left side of heart
77
Antibodies to phospholipase A2 (PLA2R)
Membranous nephropathy
78
Magnesium salts and aluminum hydroxide together for antiacid
Magnesium causes diarrhea Aluminum hydroxide causes constipation Both temporarily increase the gastric pH by neutralizing hydrochloric acid relieving reflux
79
Common source of hemorrhage from penetrating gastric ulcers
Right and left gastric arteries that run along lesser curvature of stomach
80
Saddle nose and oliguria CXR?
Granulomatosis with polyangiitis (Wegeners) Large nodular densities
81
Which testicular tumor is associated with each? 1) Composed of cytotrophoblasts and syncytiotrophoblasts? 2) May present initially with gynecomastia 3) Elevated AFP 4) Elevated beta-hCG 5) Histologic appearance similar to koilocytes (cytoplasmic clearing)
1. Choriocarcinoma 2. Leydig or sertoli cell tumor 3. yolk sac tumor 4. choricocarcinoma, embryonal carcinoma 5. Seminoma
82
Which ovarian tumor matches each? 1) Estrogen secreting leading to precocious puberty 2) Produces AFP 3) Psammoma bodies 4) Testosterone secreting leading to virilization 5) Lined with fallopian tube like epithelium 6) Ovarian tumor + ascites + hydrothorax 7) Call-Exner bodies 8) Elevated beta-hCG 9) Resembles bladder epithelium
1) Granulosa theca cell tumor 2) Yolk-sac tumor 3) Serous cystadenocarcinoma 4) Sertoli-leydig cell tumor 5) Serous cystadenoma 6) Ovarian fibroma (meigs syn) 7) Granulosa cell tumors 8) Choriocarcinoma, dysgerminoma 9) Brenner tumor
83
Which embryologic structure of the heart gives rise to each of the following? 1) Ascending aorta and pulmonary trunk 2) Coronary sinus 3) Superior vena cava
1) Truncus arteriosus 2) Left horn of sinus venosus 3) Right common cardinal vein and right anterior cardinal vein
84
What is the antidote for 1) Iron 2) Lead 3) cyanide 4) Methomoglobin 5) Carbon monoxide 6) Methanol or ethylene glycol
1) Deferoxamine 2) EDTA , succimer, dimercaprol 3) Nitraites, hydroxycobalamin, thiosulfate 4) Methylene blue, vit C 5) 100% oxygen hyperbaric oxygen 6) Fomepizole, ethanol, hemodialysis
85
Hematogenous spread of carcinomas
Four Carcinomas Route Hematogenously Follicular thyroid carcinoma Choriocarcinoma Renal cell carcinoma Hepatocellular carcinoma
86
Clearance (CL)=`
Rate of elimination of drug/ plasma drug concentration = Vd x Ke (elimination constant) Ke= 0.7/t(1/2) CL= (0.7 x Vd)/ t(1/2)
87
Loading dose=
(Cp x Vd)/ F F= bioavailability IV F= 100% Cp= target plasma conc at steady state
88
Maintenance dose=
(Cp x CL x tau)/ F tau= dosage interval (time between doses, if not administered continuously, in hours) Maintenance dose for 1 day= 24 hrs
89
Alpha 1 fxn (3)
Increase vascular smooth muscle contraction Increase pupillary dilator muscle contraction (mydriasis, dilation) Increase intestinal and bladder sphincter muscle contraction
90
Alpha 2 fxn (5)
``` Decrease sympathetic (adrenergic) outflow Decrease insulin release Decrease lipolysis Increase platelet aggregation Decrease aqueous humor production ```
91
Beta 1 fxn (4)
Increase HR Increase contractility (one heart) Increase renin release Increase lipolysis
92
Beta 2 fxn ( 7)
``` Vasodilation Bronchodilation (two lungs) Increase lipolysis Increase insulin release Decrease uterine tone ** Ciliary muscle relaxation Increase aqueous humor production ```
93
M1 fxn M2 fxn M3 Fxn
M1: mediates higher cognitive functions, stimulates enteric nervous system M2: Decrease HR and contractility of atria M3: Increase exocrine gland secretions, increase gut peristalsis, increase bladder contraction, bronchoconstriction, increase pupillary sphincter muscle contraction (miosis)
94
Preload - is what - approximated by - also measures - decreased by
Pressure at end of diastole (relaxation) when ventricles are the fullest right before contraction. Approximated by ventricular End-diastolic volume Ventricles fill from atria, atrial pressure= preload Decreased by venous vasodilators
95
Afterload - approximated by - decreased by
Approximated by Mean arterial pressure Total peripheral resistance (TPR) Decreased by arterial vasodilators
96
EDV =
Right atrial pressure
97
S1 heart sound S2 heart sound
S1= mitral and tricuspid closing S2= aortic and pulmonary closing
98
Beside maneuver 1) Inspiration 2) Hand grip 3) Valsalva, standing up 4) Squatting
1) Inspiration - increases venous return to right atrium - Increase Intensity of right heart sounds 2) Hand grip - Increase after load - Increase intensity of MR, AR, and VSD - Decrease AS murmur 3) Valsalva, standing up - Decrease preload - Decrease intensity of most murmurs - Increase intensity of hypertropic cardiomyopathy 4) Squatting - Increase venous return, increase preload, increase afterload - Increase intensity of AS, MR, VSD
99
Slurred curved upstroke (delta wave) between P and R
Wolff parkinson white Abnormal fast accessory conduction pathway from atria to ventricle (bundle of kent) bypassing AV node May result in SVT
100
Pulmonary capillary wedge pressure approximation of
left atrial pressure
101
Drugs that cause pulmonary fibrosis
Amiodarone Bleomycin Busulfan
102
Drugs taht cause flushing
Vancomycin Niacin Adenosine Dihydropyridine Ca channel blockers
103
Drugs that cause Torsades de pointes
``` Potassium channel blockers Na channel blockers Macrolides Haloperidol Chloroquine Protease inhibitors ```
104
Drugs that cause gingival hyperplasia
Phenytoin | Verapamil
105
GI bleeding | Buccal pigmentation
Peutz jegher syndrome Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands/genitalia
106
Tuberous Sclerosis
HAMARTOMASS ``` Hamartomas in CNS and skin Angiofibromas Mitral regurg Ash lead spots Cardiac rhabdomyoma Tuberous sclerosis autosomal dOminant Mental retardation renal Angiomyolipoma Seizures Shagreen patches ```
107
78 y.o to office with one month history of progressive dyspnea, generalized weakness, fatigue and palpitations. He reports tingling and numbness in both lower limbs. Hes not been taking care of himself since wife died. CV exam shows displaced apical impulse at 6th intercostal space, a third heart sound, and high volume carotid pulses. Pedal edema, mild hepatomegaly. Normal blood counts. What deficiency? ``` A. Ascorbic acid B. Cobalamin C. Niacin D. Pyridoxine E. Retinol F. Riboflavin G. Thiamine ```
G. Thiamine Wet beriberi - peripheral neuropathy - heart failure
108
Normal cardiac pressures 1) RA 2) RV 3) Pulmonary artery 4) Pulmonary artery wedge 5) LA 6) LV 7) Aortia
1) RA= < 5 2) RV= 25/5 3) Pulmonary artery= 25/10 4) Pulmonary artery wedge= < 12 (10) 5) LA= < 12 (10) 6) LV= 130/10 7) Aorta= 130/90
109
Cachexia
TNF-alpha, IFN -gamma, IL-1 IL-6
110
``` Unusually muscle movements of thumb Hypoplastic mandible Low set ears Bifid uvula Cleft palate ```
Physical features of DiGeorge syndrome Hypocalcemia
111
Schistocytes associated with
HUS, TTP, DIC and AORTIC STENOSIS
112
Structure gives rise to heart structure 1) Smooth parts of left and right ventricles 2) Smooth part of right atrium 3) Trabeculated left and right atria 4) Trabeculated parts of the left and right ventricles
1) Smooth parts of left and right ventricles - Bulbus cordis 2) Smooth part of right atrium - Right horn of sinus venosus 3) Trabeculated left and right atria - Primitive atria 4) Trabeculated parts of the left and right ventricles - Primitive ventricle

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